Pain physician
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Comparative Study Observational Study
Comparison of Robot-Assisted and Fluoroscopy-Assisted Percutaneous Kyphoplasty for Bone Cement Distribution and Clinical Efficacy.
The distribution of bone cement after percutaneous kyphoplasty (PKP) affects its clinical efficacy in patients with osteoporosis. Robotic and traditional treatment of osteoporotic vertebral compression fractures (OVCFs) have both been established as effective, but no studies have compared these 2 modalities in terms of bone cement distribution and clinical outcomes. ⋯ Robot-assisted percutaneous kyphoplasty can establish an optimal path via the unipedicular approach, thereby effectively mitigating the potential risks associated with vascular nerve and cortical bone injuries. Additionally, RAUPK ensures a more favorable distribution of bone cement and provides superior pain relief for patients. Furthermore, RAUPK has greater long-term efficacy than does FAUPK.
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Numerous studies have highlighted the escalating costs associated with managing low back and neck pain, as well as other musculoskeletal disorders. In the past, there was a notable increase in the use of interventional techniques to address these disorders. However, the COVID-19 pandemic disrupted various chronic pain treatment approaches, including interventional procedures and opioid use, following a broader trend of reduced healthcare services. Consequently, there was an 18.7% decline in the use of interventional techniques per 100,000 Medicare beneficiaries between 2019 and 2020, a stark contrast to the previous growth patterns, despite some initial declines observed starting in 2017. ⋯ This retrospective analysis demonstrates a significant reduction in the use of interventional pain management techniques from 2019 to 2022. Contributing factors to this decline likely include the lasting effects of COVID-19, economic challenges, the Affordable Care Act (ACA), and evolving local coverage determination policies.
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Observational Study
A Nomogram Model for Predicting Postherpetic Neuralgia in Patients with Herpes Zoster: A Prospective Study.
Herpes zoster (HZ) and postherpetic neuralgia (PHN) have a negative effect on patients. A simple and practical PHN prediction model is lacking. ⋯ The incidence of PHN is influenced by factors such as being a woman, being more than 50 years old, having prodromal phase pain, having a large rash area, and having great pain severity during the acute stage. The prediction model developed in this study effectively forecasts the occurrence of PHN using these 5 risk factors, making it a valuable tool for clinical practice.
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Discogenic chronic low back pain (cLBP) and radiculopathy are the most prevalent causes of disability worldwide. Older spine treatments often lack reliability and are associated with adverse events. Among surgical treatment options, discectomies weaken discs, and fusions cause direct damage to adjacent discs, so both treatments accelerate disc degeneration. Other regenerative medicine treatments, including "stem cell" (centrifuged bone marrow aspirate, BMC), and platelet-rich plasma (PRP), lack fibrin's bio-adhesive properties. Specifically, fibrin is a strong bio-adhesive, so it immediately integrates into disc defects and binds there, becoming a part of the disc and facilitating new disc tissue growth. ⋯ Intra-annular fibrin bio-adhesive sealant demonstrates the ability to be an effective treatment for alleviating discogenic cLBP and radiculopathy for at least 3 years, even in patients who all failed multiple prior treatments, including discectomy, fusion, disc PRP, or BMC. The results suggest the benefits of fibrin sealant. Future investigations to consider include a randomized double-blind controlled trial and further categorical analyses.
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Observational Study
A Novel Ultrasonographic Method to Quickly and Accurately Access the C2 Dorsal Root Ganglion.
Occipital neuralgia manifests as pain in the cutaneous distribution of occipital nerves, with the greater occipital nerve stemming from the C2 spinal nerve and the lesser occipital nerve originating from the C2 and C3 spinal nerves. While pulsed radiofrequency ablation of the C2 dorsal root ganglion (DRG) is an effective treatment for refractory occipital neuralgia, accessing the C2 DRG remains a clinical challenge even under fluoroscopic guidance. ⋯ We have developed an ultrasonographic method to quickly and accurately access the C2 DRG, which has the potential to greatly facilitate treating the C2 DRG for managing occipital neuralgia.